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Telehealth and Rising Demand for
Behavioral Healthcare
Session 221, February 14, 2019
Anne Marie Galanis, Chief Clinical Officer, FAIR Health
Copyright 2019, FAIR Health, Inc. All rights reserved.
CPT © 2018 American Medical Association (AMA). All rights reserved.
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Anne Marie Galanis
Has no real or apparent conflicts of interest to report.
Conflict of Interest
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• FAIR Health Overview
• Telemedicine and Telehealth Defined
• Behavioral Health and Telemedicine Trends
• Telehealth/Telemedicine Legislation
• Summary
• Q & A
Agenda
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• Discuss the role of telehealth in meeting the growing unmet
demand for behavioral health care services
• Identify major trends and patterns in the use of telehealth for
behavioral healthcare as shown by analysis of private claims data
• Describe how claims data analysis can be used to study
behavioral health in support of public and private sector decision
making
Learning Objectives
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FAIR Health At-A-Glance
Multi-Stakeholder
Solutions
Fulfills mission with robust data
products and custom analytics,
award-winning consumer tools
and research/policy-making
platform
Unique
Origins
Established as a conflict-
free, independent,
national nonprofit
public charity
Broad
Mission
To bring transparency
and integrity to
healthcare costs and
health insurance
information
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FAIR
Health
Value-Based
Payment
Economic
Climate
High-
Deductible
Health Plans
Narrow and
Tiered
Networks
Affordable
Care Act
Changing
Benefit
Designs
Shifting
Reimbursement
Models
Private
Exchanges
Transparency
Initiatives
Market
Consolidation
The Healthcare Market Today
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The FAIR Health Private Claims
Repository
Regions in the
United States
Medical and Dental Claims
from 2002 to the Present
Updated on a monthly basis
27+ Billion27+ Billion
150+ Million150+ Million
493493
Covered
Lives
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Insights into the Private Claims
Repository
Coverage
• All 50 states and District of Columbia
• US territories – Puerto Rico, US Virgin Islands
60+ Contributors
• National and regional payors
• Third-party administrators
Private Insurance Claims
• Fully insured and self-insured/ERISA plans
• Cover 75% of privately insured US population
Quality Testing and Control
• Data validated with expert-vetted tests for completeness, volume, accuracy, etc.
• Recognized statistical outlier methodologies exclude excessively low and high
values that distort distribution
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Growing Focus on Telemedicine and
Telehealth
American Telemedicine Association. “What is Telemedicine?” Web. Accessed February 22, 2016.
<http://www.americantelemed.org/about-telemedicine/what-is-telemedicine#.Vstv0_krKUm>
Defining Telemedicine and Telehealth
DEFINITION:
• Telemedicine - the use of medical information
exchanged from one site to another via electronic
communications to improve a patient’s clinical
health status.
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• Telehealth - more broadly includes non-clinical
services (e.g., remote training and education).
• Definitions vary by state, impacting how services
are paid for by payors.
• Provider-to-patient or provider-to-provider/
provider-to-provider and patient.
METHODS:
• SYNCHRONOUS - models that connect people
and providers in real-time:
•Electronic consultations (e.g., videoconference for
telepsychiatric screening)
• ASYNCHRONOUS - models that deliver care to
people without requiring real-time interaction:
•Remote monitoring (e.g., hospital post-discharge
monitoring)
•Store-and-Forward or other wireless
communications (e.g., capturing, storing and sharing
digital images for teledermatology diagnoses)
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Technology Supporting Synchronous
Telemedicine
Audio/Video
Conference
Mobile
Chat/Text
Telemedicine
Platform
Sources: capterra.com/tele-medicine software/
National Organization of State Offices of Rural Health. Telehealth Technologies Fact Sheet:
https://nosorh.org/wp-content/uploads/2016/11/NOSORH-Telehealth-Vendor-Fact-Sheet-FINAL.pdfs
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• Tele-ICU
– Studies point to reduced mortality and significant cost
savings.
• Tele-Stroke
– Significant potential growth area given importance of early
diagnosis/treatment.
• Tele-Behavioral Health
– Better access to care from removal of time constraints,
distance barriers and provider scarcity in remote areas.
Telemedicine Growth Areas
Sources: Telemedicine Study Cites Tele-ICU’s Positive Impact on Patients (January 25, 2017) http://mhealthintelligence.com/news/telemedicine-study-cites-tele-
icus-positive-impact-on-patients; New study demonstrates improved patient flow and financial benefits of Philips' eICU Program for managing critical care
populations (December 13, 2016) http://www.prnewswire.com/news-releases/new-study-demonstrates-improved-patient-flow-and-financial-benefits-of-philips-
eicu-program-for-managing-critical-care-populations-300377182.html?tc=eml_cleartime
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• 43.4M (est.) adults diagnosed in 2015 with a mental illness in the previous
year
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• 1 in 5 Americans will experience a mental illness in a given year.
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• 1 in 25 Americans lives with a serious mental illness, such as schizophrenia,
bipolar disorder, or major depression.
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• 55% of U.S. counties are currently without any psychiatrists
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• 10.2% reduction in the median number of psychiatrists per 100,000 residents in
hospital referral regions from 2003 to 2013.
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Telemedicine Could Meet Unmet Needs
1. Leventhal, Rajiv (2015) How Telepsychiatry is Carving Out its Healthcare Niche. Healthcare Informatics https://www.healthcare-
informatics.com/article/telemedicine/how-telepsychiatry-carving-out-its-healthcare-niche
2. Tara F. Bishop, Joanna K. Seirup, Harold Alan Pincus, and Joseph S. Ross, “Population Of US Practicing Psychiatrists Declined, 2003–13,
Which May Help Explain Poor Access To Mental Health Care.“ Health Affaires 35, no. 7 (2016).
3. Key substance use and mental health indicators in the United States: Results from the 2015 National Survey on Drug Use and Health.
Rockville, MD: Center for Behavioral Health Statistics and Quality. Substance Abuse and Mental Health Services Administration. 2016.
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Utilization of Behavioral Health Services,
2007 to 2017
0%
2%
4%
6%
8%
10%
12%
14%
16%
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
Percent of claim lines
Year
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Mental Health Distribution Comparison
0% 5% 10% 15% 20% 25% 30%
Mood Disorder - Major Depression
Adjustment Disorder - General
General Anxiety
Mood Disorder - Other
Mood Disorder - Bipolar
Attention-Deficit Hyperactivity Disorders
Adjustment Disorder - Depression
Psychological Conditions due to Physiological Condition
Adjustment Disorder - Anxiety
Post Traumatic Stress Disorder
Other Behavioral Syndromes
Panic Disorder
Obsessive-Compulsive Disorder
Schizophrenia
Dementia
All others
Percent of claim lines
Diagnoses
Mental Health Diagnoses Distribution, 2007 Compared to 2017
2017 2007
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Increasing Use of Nontraditional Care
0%
5%
10%
15%
20%
25%
30%
35%
2009 2010 2011 2012 2013 2014 2015 2016 2017
Pecent of claim lines
Year
Year-over-Year Comparison of Place-of-Service Utilization,
2009-2017
Office Urgent Care Retail Clinic
Telehealth Ambulatory Surgical Center Emergency Room
Telemedicine: 306%
Increase from 2014-2017
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United States Telemedicine Utilization, 2016
AK
HI
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Telemedicine Trends by Rural and Urban
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
2011 2012 2013 2014 2015 2016
Percent of claim lines
Year
Rural Urban Telehealth Total
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Telemedicine Usage by Age Group, 2016
0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
20%
0 to 10 11 to 18 19 to 22 23 to 30 31 to 40 41 to 50 51 to 60 61 to 70 71 to 80 Over 80
Percent of claim lines
Age group
Ages 31-60 make up the majority of
telemedicine usage.
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Telemedicine Trends by Age and Gender
0% 20% 40% 60% 80% 100%
0 to 10
11 to 18
19 to 22
23 to 30
31 to 40
41 to 50
51 to 60
61 to 70
71 to 80
Over 80
Percent of claim lines
Age group
Telemedicine is primarily used by females across all age groups except in
children ages 0-10 years old.
Female Male
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Top Diagnoses in Telemedicine, 2016
31%
Mental Health Reasons
Acute Respiratory Infections
Symptoms
Urinary Tract Infection
Arthropathies/Dorsopathies and Other Joint…
Diseases of Other Endocrine Glands
Chronic Respiratory Diseases
Other Forms of Heart Disease
Hypertensive Diseases
Influenza and Pneumonia
Circulatory and Respiratory Symptoms
All Others
0% 5% 10% 15% 20% 25% 30% 35%
Percent of claim lines
Mental Health Reasons make up 31% of all telemedicine diagnoses.
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Behavioral Health Diagnoses in Telemedicine
0% 5% 10% 15% 20% 25% 30%
Psychotic Disorder
Attention-deficit Hyperactivity Disorder
Mental Disorders Due to Known Physiological
Conditions
Adjustment Disorder
Bipolar Disorder
All Others
Major Depressive Disorder
Other Anxiety Disorders
Mental and Behavioral Disorders Due to Psychoactive
Substance Abuse
Percent of claim lines
National
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Telemedicine Identification
• Prior to dates of service in 2017 identification of telemedicine services include:
– Presence of procedure codes:
98966 – Non-physician Telephone Assessment 5-10 Min
98967 – Non-physician Telephone Assessment 11-20 Min
98968 – Non-physician Telephone Assessment 21-30 Min
98989 – Non-physician Online Assessment And Management
99441 – Physician/Qualified Health Professional Telephone Evaluation 5-10 Min
99442 - Physician/Qualified Health Professional Telephone Evaluation 11-20 Min
99443 - Physician/Qualified Health Professional Telephone Evaluation 21-30 Min
99444 - Physician/Qualified Health Professional Online Evaluation & Management Service
T1014 – Telehealth transmit, per min
G0406 – Inpatient consultation via telehealth, follow up, 15 min
G0407 – Inpatient consultation via telehealth, follow up, 25 min
G0408 – Inpatient consultation via telehealth, follow up, 35 min
– Presence of modifiers
GQ – Via Asynchronous Telecommunications System
GT - Via Interactive Audio And Video Telecommunication Systems
• After dates of service in 2017 identification of telemedicine services include:
– Previous identification
– Modifier 95 - Synchronous Telemedicine Service Rendered Via a Real-Time Interactive Audio and Video
Telecommunications System
– Place of service of 02 – Telehealth
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• Creating Opportunities Now for Necessary and Effective Care Technologies
(CONNECT) for Health Act (S. 2484)
– Removes certain Medicare restrictions on telehealth and remote monitoring services, including
originating site restrictions, geographic restrictions, and use of “store and forward” technologies.
– Permits use of telehealth and remote patient monitoring services for both medical and behavioral
health conditions.
• Creating High-Quality Results and Outcomes Necessary to Improve Chronic
(CHRONIC) Care Act of 2017 (S. 870)
– Extends the “Independence at Home” model of care for additional 2 years and expands
beneficiaries.
– Expands access to home dialysis therapy and telehealth monitoring.
– Specifies use of telehealth for individuals with stroke symptoms.
Pending Federal Legislation
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• 48 states and the District of Columbia provide reimbursement for
some form of synchronous care.
• 13 state Medicaid programs provide reimbursement for
asynchronous “store-and-forward” care.
• 22 state Medicaid programs provide reimbursement for remote
patient monitoring.
• 9 state Medicaid programs provide reimbursement for all 3.
• 6 state Medicaid programs have specific parameters based on
telepsychiatry.
Telehealth Coverage in State Law
Source: State Telehealth Laws and Reimbursement Policies, A Comprehensive Scan of the 50 States and District of Columbia, April 2017. Retrieved from the Center for Connected
Health Policy website: http://www.cchpca.org/sites/default/files/resources/50%20STATE%20PDF%20FILE%20APRIL%202017%20FINAL%20PASSWORD%20PROTECT.pdf
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• Reimbursement for synchronous care generally more common than asynchronous care,
e.g., “store-and-forward” care or remote patient monitoring.
• But, some states are allowing reimbursement for specific instances of asynchronous care,
see, e.g.:
– Connecticut – requires insurers to provide reimbursement for real-time and
“store-and-forward” telehealth patient care. CT Public Act No. 15-88 (2015 SB
467).
– Missouri – provides for reimbursement for “store-and-forward” care and remote
patient monitoring for specific specialties. MO Revised Statute, Sec. 208.670-671
(2016 SB 579).
– Nevada – requires coverage of telehealth services generally, excluding services
by electronic mail. NV Revised Statutes, Chapter 629, Sec. 510 (2015 AB 292).
– Hawaii – requires private payers and Medicaid to cover “store-and-forward” and
remote patient monitoring. HI Revised Statutes, Sec. 432D-23.5.
Telehealth Trends at State-Level
Source: State Telehealth Laws and Reimbursement Policies, A Comprehensive Scan of the 50 States and District of Columbia, April 2017. Retrieved from the Center for Connected
Health Policy website: http://www.cchpca.org/sites/default/files/resources/50%20STATE%20PDF%20FILE%20APRIL%202017%20FINAL%20PASSWORD%20PROTECT.pdf
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• The need for behavioral health services grows while the number
of providers decrease
• Telemedicine is helping to reach individuals with behavioral health
needs
• There are various technology solutions to support providing
telemedicine services that are easy to implement, but clinical
application and workflow needs to drive technology decisions
• Telemedicine legislation is still evolving at both the federal and
state levels
Summary
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• Aid decision making and research by studying trends:
– Practice patterns
– Clinical issues
– Diagnoses
– Geographic variations in healthcare prices
– Provider mix and more
• Claims databases such as our FH
®
NPIC offers all fields on a
healthcare claim
Claims Data is an Important Resource
•
Services and procedures
•
Modifiers
• Location where the service
was performed
•
Diagnosis code(s)
•
Billed charge
•
Patient age
•
Patient gender
•
Provider specialty
•
Place of service
•
Anesthesia time
•
Quantity/units
•
De-identified health
plan member ID
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Questions
STOP BY AND
LEARN MORE
VISIT US AT
BOOTH 5888
Anne Marie Galanis
Chief Clinical Officer
agalanis@fairhealth.org
646-664-1563
